ACO Update: The Rise of Physician-Led ACOs

In the June issue of Health Affairs a study was published discussing ACO’s and the rise in physician leadership within the organizations.  One of the goals of the Affordable Care Act was to hold physicians more responsible for the care of their patients, by rewarding healthcare providers for improving the quality of care and lowering healthcare costs, the ACO model was born. Slow to start, ACOs have no risen in popularity, with more than 600 Accountable Care Organizations operating throughout the U.S.

“What is an ACO? — An ACO is an accountable care organization made up of doctors, medical groups, hospitals, and other healthcare professionals who work together to deliver high-quality, coordinated care to the patients they serve.”

— Healthcare Partners

There are many various types of ACOs, some are made up of solely primary care providers, others include a variety of specialists and others encompass hospitals and post-acute care providers. However, the study showed that physician-led structures seem to be operating best, meaning they are more likely to have complete care management programs, advanced IT programs and the most satisfied patients.

Former CMS Administrator, Dr. Mark McClellan attributes this to physicians’ personal experience and ability to identify areas for improvement firsthand and measure the impact of their efforts. The Director of the Dartmouth Institute and co-author of this study, Elliott Fisher, MD, MPH stated, “Physicians’ buy-in the payment reform is likely to be critical to the success of the health care reform.” He continued to say; “The findings suggest that physicians are taking seriously their responsibility to lead change in the health care system on behalf of their patients.”

It is certainly pleasing to know that physicians are in support of these changes and are taking on the responsibility of helping to ensure the betterment of care for their patients. As more ACOs are brought together, this report will help providers determine if the path is right for them and consider which structure is best.

To read more about how ACOs originated and to view statistics on the success some organizations have found, check out the Health Affairs blog here: http://healthaffairs.org/blog/2014/05/30/aco-results-what-we-know-so-far/

Radiologist Archetypes & Mythbusters for Healthcare Marketers

Last week our team of experienced healthcare marketers sat down with Jayson A. Lord, MD to get an inside look at what makes radiologists tick.  Dr. Lord, who lives in Tampa, Florida and performs radiology for practices nationwide, discussed ways to understand radiologist motivators, tricks for how to get the good doctors involved with marketing and physician relations and spent time going through “Radiologist Mythbusters” which was a session where marketing representatives were able to state their radiologist assumptions in an open forum and discuss ways to overcome them.

One of the biggest questions Dr. Lord wanted to address was why radiologists often choose their profession. “Radiologists are typically very analytic thinkers, they love puzzles and problem solving. Radiology is the ultimate puzzle,” he said about his profession.  Getting to the root of why people choose certain paths in life intrigues Dr. Lord, and he drew from components of Jungian archetypes to explain physician motivators and the individuals who contribute to a practice’s success. The four quadrants of Jungian archetypes, which most people fall into, are The King, The Warrior, The Magician and The Joker.  As a King; individuals are filled with confidence and authority which can be a very good or very bad thing depending on the individual. The Warrior serves as a dutiful worker, while The Magician is able to utilize tricks and an engaging personality to “make things happen.”  The Joker is traditionally less motivated and looked at as the hopeless romantic of society. So which category does your radiologist fall into?

Lord says that most radiologists identify with the Warrior archetype. They want to show up to work, get through their stack of reads and move on with their systematic schedule.  Most radiologists that own their own independent practices, like Dr. Lord, fall into The King category, which can have both positive and negative influences on their work, but oftentimes responsibility rolls up the hill to the king, and most radiologists do not want to step out of their warrior roles to take on other responsibilities, leaving practices without a leader.

In order to get your radiologists more involved with marketing efforts, Dr. Lord says the key is finding your radiologist magician however. Traditionally introverted, radiologists love regiments and they need to be untrained from the clinical paradigm they’ve adopted in order to step outside of their comfort zone. In a group of radiologists, a magician can usually be found and if they are open to working with your marketing team, it can make all the difference in the world.

The key to getting started is setting up an opportunity for your radiologist to engage in a conversation with a referring physician where they will walk away feeling positive. After having a few encounters that go well, it will be less heartbreaking when they go on more challenging meetings.  It would be beneficial to set up a lunch with a clinical topic in mind to discuss for more introverted radiologists, but as long as the referring physician is engaging, a feeling of positivity can be fostered. We can compare this to someone learning to cook. If all you’ve ever made is grilled cheese, you would not delve into your first cooking adventure aiming to perfect soufflés or prepare a full Thanksgiving meal. You would start with the basics: baked chicken, some steamed veggies and pasta. The same can be said about easing radiologists into marketing efforts.

As healthcare marketing professionals, it is important to be able to read people, understand what their needs and motivators are, and to use that information to grow.  Figuring out what kind of radiologist you work with and finding your internal Magician could lead to exponential levels of success for your center.

Emotions & Loyalty: Root of Patient & Physician Decisions in Health Care

People are people, whether they are identified by their career or their role in the health care process. So whether you’re dealing with a referring physician or a patient, it’s important to consider emotions, their role in the sales process and how they drive and destroy value.  One of the most valuable emotions to have in our business is loyalty. Loyalty is what providers work towards with referring physicians and what they’re trying to earn from their patients, and in a society where health care is catching a lot of heat for a lack of transparency, loyalty and honesty are key.

Lloyd Banks said, “I take things like honor and loyalty seriously. It’s more important to me than any materialistic thing or any fame I could have.” It’s funny because a lot of practices think that the best way to attract referrals is to give gifts and tip-toe through shades of gray, tickling the line of propriety and Stark Laws, whether they can afford it or not.  Matt Schneider says that when your relationships are built off of gifts however, you’re only as good as your next present. Don’t think about yourself and your service from a strictly monetary scope, consider your value, because it is more important than any materialistic thing you could provide, as long as you’re not handing out keys to new Ferraris.

In Colin Shaw’s program Beyond Philosophy, he points out that in sales, professionals brand their customer experiences with their own emotional signatures. Over 50% of a customer’s experience relies on how they feel, which will then either drive or destroy their decision path. With 20 emotions ranging from happy to trusted to disappointed to neglected; your perception of value hinges heavily on your customers’ emotions, indicating whether they will become long-term, short-term or no-term customers. In health care it is hard to look at patients as “customers” but their emotional drive is intrinsically the same.

 (See image here: http://pinterest.com/pin/177399672791761465/) 

It makes sense that in health care, more than in any other industry, emotional-selling plays a vastly important role. From a patient perspective, the health care industry is a confusing, money-hungry monster that is supposed to be able to fix the illusive medical issues they face before they die. They are operating in a state of flat out fear. Transparency in the system is a good start to helping patients sort through their emotions, aiding in their comprehension of what happens with their doctors and the bills that come out of their appointments. This is why it’s important for health care marketers and physicians to enter the conversation that patients are having already in their minds about price and quality.

The jump from reaching and making an impact on referring physicians is not all that far off as emotions go. Doctors have their own set of worries, whether it be about; patient loyalty, patients wellness, happy staff, having enough time to get everything accomplished, all while making money and keeping their practice alive.  This is especially challenging for independent physicians that don’t have the support of a hospital system.

Trends towards independent physicians getting bought out by hospital systems have cut down the number of private practices and many physicians and patients have been left wondering why hospital-owned physicians decided to sell.  The root of all patient and physician decisions resorts back to loyalty; emotional and financial support and security. With the changes that will occur over the next few years in our profession, we predict the rise of patient loyalty to independent physicians due to their ability and freedom to adopt transparency and patient-focused quality care.

Transparency's Effect On Doctors Ordering Imaging Procedures

Recent articles point to physicians saying that they’ve been ordering imaging procedures at an increasingly alarming rate. These doctors, according to reports, are ordering expensive scans without taking into consideration the financial burden that is then placed on their patients.  It is for this reason that patients must be able to access better information about their care and information about the price of those necessary procedures.

            The Journal of the American College of Radiology recently decided to research this trend because patients need to be able to know going into an imaging procedure what it is going to cost them, whether they’re insured or not. Daniel J. Brotman, M.D. researched this occurrence at Johns Hopkins Hospital. Brotman studied a group of doctors for six months, during which time the doctors were not given the price of each imaging procedure they ordered. Then for six more months they got access to the pricing of ordered procedures before they prescribed them to their patients. It appeared that the number of procedures ordered did not differentiate a substantial amount from one test period to the next.

            These results do not lean in favor of the patient. For a long time doctors have been ordering procedures and not taking into consideration the financial burden on the patient. However, many would argue that it is not the doctor’s responsibility to be concerned over price, but rather to be focused on the wellness of their patient. Brotman says; “Cost transparency must be part of the solution to solving fiscal challenges in medicine,” this starts with our doctors. Price transparency is something that people can rely on in order to alleviate some of the stress of an imaging procedure, so that they do not need to go without necessary services.

            Independent radiology centers have an advantage over hospitals because of the relationships that can be formed between doctor and patient. Doctors and hospitals are dealing with a large amount of patients everyday which hinders their ability to form a greater relationship with patients. Since there is a minimal relationship doctors are not in a position to be concerned with a patient’s financial background. With this they simply look at what the patient needs to have done in order to get well regardless of the price. Doctors at independent centers have the ability to form a more in depth relationship because they do not have to handle near the amount of patients. With this comes better care, which is a key element in the process of having a procedure done. There are many advantages when seeing an independent radiology center, care and price are just a couple.

            Save On Medical is a website that can help provide the patient with price transparency, providing them with centers where they can go to find affordable care. Patients are able to compare facility costs between different independent centers in their area. Patients can also see the quality of the doctor at each location on Save On Medical. Save On Medical gives patients in need of imaging procedures the ability to compare prices well as compare quality of doctors. This information helps ease the hassle of finding health care, while also, taking some of the pressure off of the shoulders of physicians who are being scolded for over-prescribing scans. 

Why Doctors Should Stop Battling Transparency

Demands for quality and price transparency in all sectors of healthcare have journalists, patients and healthcare companies alike, believing that it could be the cure-all for our broken system.  Billions of dollars have been reported over-spent in the industry and it is clear that we need a solution, so why is it so hard for doctors to accept that transparency could be the first step?

As care providers, there are a number of issues that we could have with the full transparency model. The most apparent is a doctor’s concern with being commoditized, especially if their procedures are considered high-ticket price services. If a patient has to come out-of-pocket to pay for a procedure, the likelihood that the procedure will be put off is high.  This is a common concern for radiologists especially, who have uninsured patients or patients in need of studies for elective procedures. 

What most physicians concerned about commoditization don’t realize, is that by “succumbing” to transparency, they can become more competitive with their pricing strategies. For example, if a patient is able to compare your quality in comparison with your less appealing competition and your pricing is the same, your patient can make their own educated decision and a wiser choice. You can bet 10-to-1 that when pricing is the same, higher quality will win out, even in healthcare where high price does not necessarily point to high quality.

Traditionally, patients have made their care decisions based off of word of mouth. Whether a family member, friend or their physician advises them; other people’s opinions of your practice matter to your potential patients. So, most commonly if a doctor tells a patient they need further care, the patient will go wherever they tell them to go. Times, they are a’changing though. Patients are becoming more consumer-driven which means that having your pricing and quality available makes you more accessible to a growing patient population.

For particularly price-sensitive patients, listing yourself on transparency websites could make all the difference, especially if other similar or competing practices are still batting the need for transparency.  It is equally as helpful to referring offices with patients in need of affordable options, because they won’t have to waste time calling around to various practices for pricing. 

Physicians do not like to change their ways. It is as simple as that. Transparency however, is an aspect of change that is on the horizon for all of us, just as much as EMRs and social media, so the sooner you jump on board, the better.